actabiomedicaActa Biomedica ScientificaActa Biomedica Scientifica2541-94202587-9596Scientific Centre for Family Health and Human Reproduction Problems10.29413/ABS.2022-7.5-2.5actabiomedica-3824Research ArticleВНУТРЕННИЕ БОЛЕЗНИINTERNAL DISEASESИспользование в клинической практике метода индуцированной мокроты у пациентов с бронхиальной астмойUsing induced sputum method in clinical practice in patients with bronchial asthmahttps://orcid.org/0000-0002-0952-6856ЧулковВ. С.ChulkovV. S.

Чулков Василий Сергеевич – доктор медицинских наук, профессор кафедры факультетской терапии

454092, г. Челябинск, ул. Воровского, 64

Vasiliy S. Chulkov – Dr. Sc. (Med.), Professor at the Department of Intermediate-Level Therapy

Vorovskogo str. 64, Chelyabinsk 454092

vschulkov@rambler.ruhttps://orcid.org/0000-0002-1405-251XМининаЕ. Е.MininaE. E.

Минина Елена Евгеньевна – кандидат медицинских наук, старший лаборант кафедры факультетской педиатрии им. Н.С. Тюриной

454092, г. Челябинск, ул. Воровского, 64

Elena E. Minina – Cand. Sc. (Med.), Senior Teaching Assistant at the Department of Intermediate-Level Pediatrics named after N.S. Tuyrina

Vorovskogo str. 64, Chelyabinsk 454092

eminina79@mail.ruhttps://orcid.org/0000-0002-1906-8465МедведеваЛ. В.MedvedevaL V.

Медведева Лариса Валентиновна – кандидат медицинских наук, доцент кафедры факультетской педиатрии им. Н.С. Тюриной

454092, г. Челябинск, ул. Воровского, 64

Larisa V. Medvedeva – Cand. Sc. (Med.), Associate Professor at the Department of Intermediate-Level Pediatrics named after N.S. Tuyrina

Vorovskogo str. 64, Chelyabinsk 454092

larisa-medved@yandex.ruФГБОУ ВО «Южно-Уральский государственный медицинский университет» Минздрава РоссииSouth Ural State Medical University20221012202275-24255Copyright © Чулков В.С., Минина Е.Е., Медведева Л.В., 20222022Чулков В.С., Минина Е.Е., Медведева Л.В.Chulkov V.S., Minina E.E., Medvedeva L.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.actabiomedica.ru/jour/article/view/3824

В статье изложен обзор современных представлений о методе индуцированной мокроты, представлены подробное описание методики и протоколы получения мокроты у взрослых и детей, способы обработки полученного материала. В работе детально описываются особенности клеточного состава индуцированной мокроты у здоровых людей и у пациентов с бронхиальной астмой; подчёркивается значимость уровня эозинофилии как прогностического и диагностического критерия астмы; определяются функции других клеток индуцированной мокроты, таких как нейтрофилы, макрофаги, базофилы. Работа иллюстрирована фотографиями микроскопии мокроты. Помимо цитологии мокроты, подчёркивается возможность использования других методов исследования, таких как идентификация вирусных и бактериальных возбудителей, геномика, протеомика, липидомика, метаболомика, определение концентрации различных медиаторов в супернатанте мокроты. Даются представления о биохимических маркерах воспаления и ремоделирования дыхательных путей при астме, которые можно определить в мокроте (анафилатоксин С3а, кластерин, периостин, нейротоксин эозинофильного происхождения, фолликулин). Кроме того, в статье обобщены сведения о воспалительных фенотипах бронхиальной астмы, подчёркиваются их непостоянство и модификация в зависимости от периода заболевания, назначенного лечения, интеркуррентных респираторных инфекций, курения. Даны подробные характеристики эозинофильного, нейтрофильного, смешанного и малогранулоцитарного фенотипов бронхиальной астмы, отражены наиболее частые корреляции фенотипов с тяжестью и течением заболевания, параметрами функции лёгких и другими показателями. Описаны возможности использования метода индуцированной мокроты для комплексной оценки течения, контролируемости астмы и эффективности проводимой лекарственной терапии, а также для персонализированного подбора противовоспалительного препарата с учётом воспалительного фенотипа.

This article presents an overview of modern statements of the induced sputum method; detailed description of the methods and protocols for taking sputum in adults and children, methods for processing the obtained substance. The paper describes in detail the features of the cellular composition of induced sputum in healthy individuals and in patients with bronchial asthma, emphasizes the importance of the eosinophilia level as a prognostic and diagnostic criterion of asthma and also determines the functions of other induced sputum cells such as neutrophils, macrophages, basophils. The article is illustrated with photographs of sputum microscopy. In addition to sputum cytology, we give accent to the possibility of using other research methods such as an identification of viral and bacterial pathogens, genomics, proteomics, lipidomics, metabolomics, determination of the concentration of various mediators in the sputum supernatant. The paper presents the ideas on biochemical inflammatory markers and remodelling of the respiratory tract in asthma, which can be determined in sputum (C3a anaphylatoxin, clusterin, periostin, eosinophil-derived neurotoxin, folliculin). In addition, we summarize the information on inflammatory phenotypes of bronchial asthma, emphasize their variability and modification depending on the period of the disease, prescribed treatment, intercurrent respiratory infections, and smoking. The article also presents detailed characteristics of eosinophilic, neutrophilic, mixed and small granulocyte phenotypes of bronchial asthma, and describes the most frequent correlations of phenotypes with the severity and course of the disease, with lung function parameters and other indicators. The paper gives an account of the possibilities of using the induced sputum method for a comprehensive assessment of the course, asthma controllability and the effectiveness of drug therapy, as well as for a personalized selection of an antiinflammatory drug considering the inflammatory phenotype.

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The authors declare that there are no conflicts of interest present.